You are an LPN working on a medical-surgical floor in a team that consists of an RN and a medical assistant. Read through some of the chart entries over a 48-hour period and answer the questions at the end. Please make sure you cite any sources using APA format. You will find when there is a major clue.

0130: Admission nurses note (RN): Client arrived via EMS from long-term-care for evaluation of “low blood sugar.” Pt. arrived confused (alert and oriented X 1) and is a known diabetic. Finger stick was 45. Orange juice and crackers, given repeat finger stick 104. Pt now alert and oriented X 4. Report from the charge nurse at the long-term-care facility indicates that the client has been having frequent bouts of hypoglycemia.

0530: (RN) Foley catheter inserted for incontinence–pt. “too weak” to get up to the bathroom and is experiencing bouts of incontinence.

600 mL clear yellow urine noted. The nurse indicates that the ER is “very busy” and “short-staffed.” 0545 (Admitting Physician) See history and physical. Pt. admitted to the medical-surgical service for evaluation of recurrent hypoglycemia.

View the ER chart before the pt. is transferred to the floor:

0730: (RN) Report is given to RN on 3 North.

Emergency Department Chart

Client: Mabel Simpson

DOB: 4/23/1941

Admission Date 8/16/2019

Medical Diagnosis: recurrent hypoglycemia

Allergies: None

Vitals/ Data Collection: Temp.- 97.3 PO

History: Diabetes (insulin dependent)  

Medications: Insulin R titrated to finger sticks

Allergies: None

Vitals/ Data Collection: Pulse- 68

History: Hypertension

Medications: Furosemide 20 MG twice per day

Allergies: None

Vitals/ Data Collection: Respirations- 18

History: Atrial Fibrillation

Medications: Warfarin 5 Mg Mon, Wed, Fri 2 Mg Tues, Thurs

Allergies: None

Vitals/ Data Collection: Blood Pressure- 122/86

History: Rheumatoid Arthritis   

Medications: Enalapril 5 Mg once per day

Allergies: None

Vitals/ Data Collection: No C/O pain

History: Mild Heart Failure (class 1)

Medications: Proventil inhaler as needed for wheezing

Allergies: None

Vitals/ Data Collection: Alert and oriented X 4

History: Former Smoker- smoked 1 pack per day X 40 years- last smoked 10 years ago

Medications: Methotrexate 2.5 Mg per day

Allergies: None

Vitals/ Data Collection: Lungs: No adventitious sounds

History: Appendectomy as a child

Medications: Tylenol 650 Mg as needed for pain or fever

Allergies: None

Vitals/ Data Collection: + Bowel sounds

History: Mobility (baseline): able to ambulate slowly with minimal assist

Clear yellow urine draining from Foley catheter in adequate amts.

Medications: 

Allergies: None

Vitals/ Data Collection: Clear yellow urine draining from Foley catheter in adequate amts.

History: 

Medications: 

Allergies: None

8/16/2019

10:00: (RN) Pt received on 3 North. Alert and oriented X 4. Fingerstick 81. Eating breakfast. Offering no complaints.

8/17/2019 (Medical Assistant)

0130: Sleeping Soundly

0700: (LPN) alert and oriented Finger stick 124. Offering no complaints. Medications given as ordered. Foley catheter draining cloudy yellow urine- RN notified.

1100: (Case Manager note): Pt. alert and oriented. Blood sugar stable. Will speak to the physician about discharge tomorrow morning.

1300: (Physical Therapy): Ambulated to the hallway 200 feet. Ambulates slowly- baseline as per long-term-care facility charge nurse. Recommend physical therapy after discharge, however, ambulated well enough for discharge.

1600: (LPN) Pt found to be confused (alert and oriented X 1). RN notified. Fingerstick 130. Vitals 97.5 (axillary), 110, 24, 98/64

1800: (Medical assistant) 400 cc’s emptied from catheter bag.

0100: (RN) Pt confused and combative. Attempting to pull out her IV and repeatedly removing her gown. Pt’s physician was paged- ordered Lorazepam 1 MG IM. Medicated as ordered and slept the remainder of the night with no incident.

0700: (RN) Pt awake and alert but combative. Finger stick-124. Vitals: 98.9 (axillary), 116, 28, 90/55

1730: (LPN) Unable to administer medication. Pt appears extremely confused. RN notified.

1200: (LPN) Pt’s daughter at bedside. Daughter indicates that her mother is not normally confused and is concerned that she may have had a stroke and notes that her mom feels “very warm.” RN notified. Foley catheter draining cloudy urine.

1230: (Medical Assistant) Vital signs: T 103.6 (rectal), P=130, BP=84/43, resp rate=28

1300: (RN) Rapid response called (because of the change in condition) and client transferred to the ICU.

Update: The client spent 3 days in the ICU but unfortunately did not recover.

Please answer the following questions:

1. Why did this client become confused and combative? (5-10 sentences)
2. What pivotal decision made in the ER directly caused this client’s worsening condition? (1-2 sentences)
3. What type of incontinence did this client have? Explain your answer. (5-10 sentences)
4. What factors in the client’s medical history contributed to the client’s change in condition? (5-10 sentences)
5. How did communication (or lack thereof) contribute to the poor outcome for this client? (5-10 sentences)

 

Examine the high-risk nutritional behaviors associated with different cultures. Identify the historical perspectives, belief systems, and other factors associated with these high-risk nutritional behaviors for each culture. Write a 1,500-3,000-word paper on your findings in which you accomplish the following:

1. Summarize the high risk-nutritional behaviors practiced among two or three different cultures.
2. Discuss the historical perspectives and belief systems of these cultures that influence the high-risk nutritional behaviors.
3. Discuss the role of the health care provider in caring for individuals with high-risk behaviors for each culture. These may include, but are not limited to (a) education, (b) family roles, (c) spiritual beliefs, (d) health care practices, and (e) drug and alcohol use.

This paper requires minimum of two outside resources in addition to the textbook. Be sure resources are current within the last five years.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

PUB-550-RS2-HealthBehaviorDataset.xlsx

 

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
• Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
• Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course. 

By Day 3 of Week 4

Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

By Day 6 of Week 4

Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.